Questions for Dr. Stern
About Your Urgent Care Center
119. What is the best way to bill for observation of a patient, in addition to the e/m code?
Prolonged observation in the urgent care setting can be coded with the following codes.
- 99354Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (eg, prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour (List separately in addition to code for office or other outpatient Evaluation and Management service)
- 99355 Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (eg, prolonged care and treatment of an acute asthmatic patient in an outpatient setting); each additional 30 minutes (List separately in addition to code for prolonged physician service)
One caveat: These codes require the provider to be “face-to-face” for the entire time that is used for calculating the proper code. For example, code 99354 can be used if the physician spends 45 minutes in the room caring for a very ill patient. Do not, however, use these codes simply to code for time that the patient ties up a room while getting nebulizer treatments or hydration therapy. In the urgent care setting, it is very rare for the physician to spend this amount of time in “face-to-face” contact with the patient. Thus, it is very rare that these codes would be appropriate in the urgent care setting.
